Whether the daily challenges of living with multiple sclerosis (MS) or the disease process itself is to blame, depression is a widely suffered but little-shared symptom for many patients.
With the untimely passing of comedian Robin Williams, the taboo topic of depression has been brought out of the darkness. Like so many other chronic conditions, MS often goes hand in hand with depression, and researchers are trying to figure out why.
Is It All in Your Head?
A collaborative study led by neurologist Dr. Nancy Sicotte, director of the Multiple Sclerosis Program at Cedars-Sinai Medical Center in Los Angeles, recently found that certain types of depression are caused by changes in the hippocampus. The hippocampus is a small structure located deep inside the brain.
In the study, published in Human Brain Mapping, researchers assessed 109 women with MS for depression and examined their brains using MRI scans. They were able to identify tissue loss in a specific area of the brain that controls mood in those volunteers who had depression.
The researchers discovered that depression appears to be linked to damage in the right side of the hippocampus. The hippocampus is responsible for emotions and the creation and storage of memories.
Learning how the MS disease process can affect mood will help scientists discover more effective ways to treat depression in MS patients.
Living Under a Cloud
While the study results offer hope for better treatments in the future, they provide little consolation for those coping with MS and depression right now.
“I am on 18 medications,” Michelle Kaufman, who was diagnosed with both MS and depression, told Healthline. “I am now on my third MS medication and of course I take medication for depression.”
Kaufman, a former nurse, was declared disabled last year and yearns for her old life. “I miss work terribly. I miss working with my patients. I miss my friends,” she said. Her illness started interfering with work, resulting in time off, which only complicated matters and made her feel like a burden on her family.
Ashley Furnier agrees that living with both MS and depression can be overwhelming. A mother of three small children, she told Healthline, “It's hard to stay positive when all I want to do is cry some days.”
Neurologists understand that MS and depression can go hand in hand. They are trained to be on the lookout for changes in mood or behavior and to routinely test for any changes during an exam.
Many factors can contribute to depression, explained Dr. Kalina Sanders, a neurologist with University of Florida Health. These include changes in neurotransmitter chemicals and the location of brain lesions, as well as trouble adjusting to life with a chronic illness. Sometimes even the cocktail of medications a person with MS has to take to manage their symptoms can bring on depression.
“As many of the symptoms of depression can overlap with symptoms of MS, I believe the biggest clue is if they lose interest,” Sanders told Healthline. Not caring about things that used to bring them happiness, mood changes, or expressing feelings of worthlessness can all be signs of depression.
To treat depression, “I recommend a combination of antidepressants and psychotherapy,” Sanders said.
Don't Be Afraid to Get Help
Friends and family might not understand that depression is out of a person's control. They cannot just “snap out of it.” Lack of understanding can leave patients feeling frustrated and helpless.
“There still remains a stigma about mental illness,” Sanders said. So patients are often reluctant to share their depression diagnosis.
Indeed, most of the MS patients interviewed by Healthline preferred to remain anonymous. When asked who they had shared their depression diagnosis with, one respondent confided, “I don’t share. You are the first.”
If you are diagnosed with depression, work with your doctor to find a solution. Neither MS nor depression are one-size-fits-all diseases. Finding a treatment that works for you might take some trial and error.
Besides prescription medications, some people have successfully treated depression with talk therapy, meditation, or hypnotherapy.
“I have my good days and bad,” Kaufman confessed. “I used to multitask well and have such an awesome memory and now I think of myself as Dory in ‘Finding Nemo.’ Just keep swimming.”